Our Summary

This study aimed to determine the rate at which bones fail to properly heal (a condition known as “non-union”) after a surgical procedure designed to fuse the subtalar joint, which is located in the foot. The researchers also wanted to identify any risk factors that might increase the chances of non-union and to evaluate how well patients functioned after the surgery.

The study focused on patients who had this type of surgery between 2000 and 2013, and who already had a form of arthritis in the subtalar joint caused by previous injury. The researchers looked for potential risk factors such as needing to have the surgery repeated, history of infection in the surgical area, obesity, diabetes, smoking, and alcohol abuse.

The researchers confirmed whether the bones had properly fused by using x-rays or CT scans and assessing the patients for ongoing pain or functional problems. They measured how well patients were doing using several standardized scoring systems, including one specifically designed for the type of surgery being studied.

The study included 214 patients who had a total of 267 surgeries. The majority of the patients were men, and the average age was 49. More than half of the patients had a specific type of heel bone fracture.

The researchers found that the rate of non-union was quite high, around 24%. However, when patients didn’t have any of the risk factors mentioned above, the rate of non-union dropped to 12%. The presence of infection was identified as a major risk factor for non-union.

The study concluded that the failure of bones to properly fuse after this type of surgery can be attributed to various risk factors, with infection being particularly significant. The more risk factors a patient has, the greater the chance that the bones will not properly heal.

FAQs

  1. What is the rate of non-unions after arthrodesis of the subtalar joint?
  2. What are the identified risk factors for non-union after subtalar fusion?
  3. How was the outcome of subtalar fusion measured in this study?

Doctor’s Tip

A helpful tip a doctor might tell a patient about joint fusion, particularly subtalar fusion, is to avoid smoking and alcohol abuse as these factors have been shown to increase the risk of non-unions. It is important to follow post-operative instructions carefully to optimize the chances of successful fusion. Additionally, maintaining a healthy weight and managing any underlying medical conditions, such as diabetes, can also improve outcomes. Regular follow-up appointments with your healthcare provider are essential to monitor progress and address any concerns promptly.

Suitable For

Patients who are typically recommended joint fusion are those with post-traumatic osteoarthritis of the subtalar joint. This study specifically looked at patients with this condition who had undergone subtalar fusion. Risk factors for non-union after arthrodesis included revision surgery, infection history in the area of operation, obesity, diabetes, cigarette smoking, and alcohol abuse. Patients with multiple risk factors were more likely to experience non-union. Infections were found to be a major negative predictive factor for successful fusion. The study found a non-union rate of 23.8% in patients with post-traumatic osteoarthritis undergoing subtalar fusion.

Timeline

Before joint fusion:

  1. Patient experiences post-traumatic osteoarthritis of the subtalar joint.
  2. Patient may undergo revision surgery, have a history of infection in the area of operation, be obese, have diabetes, smoke cigarettes, or abuse alcohol.
  3. Osseous consolidation is confirmed through x-ray or CT-scan.
  4. Patient may experience consistent pain or functional disorders.

After joint fusion:

  1. Non-union rate is found to be 23.8% with the presence of risk factors, compared to 12% without any risk factors.
  2. Infections have a high odds ratio for non-union.
  3. AOFAS hindfoot score is measured to evaluate functional outcome, with scores of 49 ± 20 after primary arthrodesis and 46 ± 17 after secondary arthrodesis.
  4. Presence of infection is a major negative predictive factor for osseous consolidation.
  5. Summation of risk factors increases the chance for non-union.

What to Ask Your Doctor

  1. What is the success rate of joint fusion in patients with post-traumatic osteoarthritis of the subtalar joint?
  2. What are the risk factors for non-union after joint fusion in the subtalar joint?
  3. How can I minimize my risk of non-union after joint fusion?
  4. How will I know if the fusion has been successful, and what imaging or clinical assessments will be used to monitor this?
  5. What is the expected functional outcome after joint fusion in the subtalar joint?
  6. How will my pain and function be assessed post-operatively?
  7. Are there any lifestyle changes or habits I should modify to optimize the outcome of joint fusion surgery in the subtalar joint?
  8. What is the likelihood of needing revision surgery after joint fusion in the subtalar joint?
  9. How long is the recovery process after joint fusion surgery in the subtalar joint?
  10. Are there any specific complications or risks associated with joint fusion in the subtalar joint that I should be aware of?

Reference

Authors: Ziegler P, Friederichs J, Hungerer S. Journal: Int Orthop. 2017 Jul;41(7):1387-1393. doi: 10.1007/s00264-017-3493-3. Epub 2017 May 8. PMID: 28484796